Being referred or recommended for minimally invasive endoscopic surgery? Are you sure you understand the procedure being recommended? Don’t just sit on your hands. Raise them and ask questions, advises world-renowned endoscopic spine surgeon Dr. Kaixuan Liu, MD, PhD.
“Endoscopic spine surgery is an advanced, state-of-the-art approach that has revolutionized the treatment of a wide variety of conditions causing back and neck pain. But, despite their clinical successes, endoscopic spinal procedures are not without risks, and results can vary depending on the overall age and condition of the patient and the specific problem being addressed,” says Dr. Liu, founder and medical director of the Atlantic Spine Center and the Advanced Spine Surgery Center in New Jersey and New York.
Patients should not simply make assumptions, he adds.
“The significance of the spine cannot be overstated. It serves as the body’s central support structure and protects the spinal cord, which is a key component of a person’s central nervous system,” Dr. Liu states. “That’s why a patient must be fully informed – and given all options and possibilities – before agreeing to any procedure affecting the spine.”
He points specifically to a study just recently published (March 2022) in the Journal of Healthcare Engineering. In it, the authors write, “Percutaneous spinal endoscopic technology has obvious advantages in reducing nerve root injury, dural injury, and surgical area wound complications.” But they add, “For each clinical surgeon, the complications of a herniated disc surgery are a great challenge; so, it is only fully and systematically important to know and grasp the surgical complications.”
Minimally invasive endoscopic surgery involves the surgeon’s use of a tubular instrument called an endoscope that is equipped with a high-definition camera and light to “visualize” the treatment area. The endoscope is inserted through a tiny incision, creating a working channel through which the physician can then manipulate micro-surgical instruments and correct the spinal problem causing the patient discomfort and pain.
The operation is usually performed on an outpatient basis, and the patient normally leaves the hospital within a few hours following the herniated disc surgery. Advantages of this type of surgery include quick recovery with minimum pain, less trauma and damage to soft tissues, reduced need for postoperative medications, preservation of spinal mobility, and a high success rate. The procedure is most effectively used for:
- Enlarging the spinal root canal to relieve compression of nerves due to a herniated disc, excessive ligaments, or bone spurs.
- Removing herniated disc material impinging spinal nerves and causing debilitating pain or numbness in the legs or arms.
- Deadening nerves that promote ongoing neck and back pain.
“Yet, there are no guarantees. A patient’s back pain might not be entirely eliminated by endoscopic surgery, and an additional, later procedure may be required. In older patients, herniated disc surgery cannot reverse aging’s effects on the spine and spinal deterioration – no matter how advanced the procedure,” Dr. Liu explains. “As spinal specialists, we must provide patients with realistic expectations of what surgery can – and cannot – do for them.”
Dr. Liu’s concerns are echoed by investigators in a 2018 edition of the journal Neurospine. “Degenerative spine disease, encompassing disc prolapse and stenosis, is a common ailment in old age,” the researchers state. “Management of degenerative spine disease in elderly patients with multiple comorbidities is a challenging task.”
Meanwhile, scientists writing in a 2020 issue of the International Journal of Spine Surgery note a “high rate of positive outcomes with endoscopic thoracic spine surgery, which reduces tissue dissection, intraoperative blood loss, and epidural fibrosis. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field.”
So, what kind of information should a patient, age 20 or age 85, obtain when considering back surgery as a treatment option?
Preparing for spine surgery is a significant decision that requires careful consideration and thorough understanding. Prior to undergoing such a procedure, it is essential to gather as much information as possible and address any concerns or questions you may have. By engaging in meaningful discussions with your healthcare provider, you can ensure that you are well informed and make the best decisions for your health.
To help guide your conversation, we have compiled a list of 15 important questions to ask prior to spine surgery. These questions cover various aspects of the surgical process, including the rationale behind the recommendation, alternative treatment options, potential risks and benefits, expected recovery time, and post-surgery care. By asking these questions, you will gain a comprehensive understanding of the procedure, its potential outcomes, and the necessary steps for a successful recovery.
“First and foremost, patients need to inquire whether an operation, minimally invasive or not, will likely ‘fix’ or, at least, relieve their back or neck pain and how many similar procedures has their surgeon already successfully performed,” Dr. Liu notes. “Unless there is a high degree of probability for a positive outcome, patients should seriously question whether or not to proceed. Spinal surgery always comes with risks – no matter how advanced the procedure.”
Other questions patients are advised to ask pending surgery, Dr. Liu says, include:
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- What possibly could go wrong in back surgery? Could surgery worsen my problem?
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- How difficult will be the recovery period? Will I need assistance at home following my procedure?
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- How long will spinal stenosis surgery keep me in the hospital?
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- Do I have other non-surgical treatment options to consider before agreeing to an operation?
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- Would there be any exacerbation of my problem if surgery were delayed? Would my condition only worsen if I avoid surgery?
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- Is minimally invasive endoscopic surgery the optimal approach for treating my issue?
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- What lifestyle changes, if any, should I make prior to scheduling spinal stenosis surgery?
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- Will postsurgical pain management be an issue?
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- How will the back/neck surgery affect my daily routine or activities? Will I regain normal functions?
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- What specific spine condition do I have, and why is surgery recommended?
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- What are the potential benefits and risks associated with this surgery?
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- What is the success rate of this particular procedure?
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- What type of anesthesia will be used, and what are its potential side effects?
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- What is the anticipated level of pain following the surgery, and how will it be managed?
- 15.Are there any lifestyle modifications or changes in activity that I should be aware of post-surgery?
Some other questions worth asking are:
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- How many similar procedures have you performed, and what are your success rates?
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- Can I speak with any previous patients who have undergone the same surgery?
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- Are there any specific preoperative preparations or tests required?
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- What are the long-term expectations for pain relief and functional improvement?
Remember, it is essential to have open and honest communication with your healthcare provider. Don't hesitate to seek a second opinion or ask for clarification if needed. Being well-informed and understanding the details of your spine surgery can contribute to a smoother recovery and improved overall outcome.
“The bottom line: surgery is your decision to make but be sure it is an informed decision. Always proceed cautiously. You cannot undo a procedure once it has been performed. So, ask now,” Dr. Liu emphasizes.
Watch our video on the anatomy of your spine: https://www.youtube.com/watch?v=gUG_zbKqlaU
